Skip directly to site content Skip directly to search


Español  Other Languages


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search

		Submit


Traumatic Brain Injury & Concussion


Section Navigation
			
			CDC Home


Facebook
        Twitter
        LinkedIn
        Syndicate





CDC Pediatric mTBI Guideline Checklist										Related Pages
										CDC Pediatric mTBI Guideline Checklist: For healthcare providers treating children 18 years of age and younger.
Assess
**Conduct a physical examination to identify findings that:**
Suggest more severe TBI (e.g., hemotympanum, pupillary asymmetry).
May impact management of mTBI (e.g., concurrent injuries or baseline deficits, oculomotor dysfunction).
Suggest other contributions to symptoms (e.g., dehydration, cervical tenderness, scalp hematoma).
**Do not image routinely (including CT & MRI).**
Use validated clinical decision rules predicting risk for more severe injury to determine need.**A combination of risk factors that may indicate need for neuroimaging include:**
Age < 2 years oldRecurrent vomitingLoss of consciousnessSevere mechanism of injurySevere or worsening headacheAmnesiaNon-frontal scalp hematomaGlasgow Coma Score < 15Clinical suspicion for skull fracture**Assess symptoms using validated scales. Consider cognitive and balance testing.****Examples of validated scales include, but aren’t limited to:**
Post-Concussion Symptom Scale
Health and Behavior Inventory
Post-Concussion Symptom Inventory
Acute Concussion Evaluation**Conduct a history to identify risk factors for poor prognosis using validated prediction rules.****Factors associated with poor prognosis:**
Older age (older children/adolescents) or Hispanic ethnicity
Lower socio-economic status
History of intracranial injury
Premorbid histories of mTBI or increased pre-injury symptoms
Neurological or psychiatric disorder
Learning difficulties or lower cognitive ability
Family and social stressorsCounsel
**Provide information about:**
Warning signs that injury may be more serious.A headache that gets worse & does not go away
Significant nausea or repeated vomiting
Increased confusion, restlessness, or agitation
Slurred speech, drowsiness, or inability to wake up
Weakness, numbness, or decreased coordination
Loss of consciousness, convulsions, or seizures
Typical recovery course.
How to prevent further injury.
Gradual re-introduction of activity that does not worsen symptoms.
The need for social and emotional support.
**Offer clear instructions (preferably verbal and written) on return to activity, including school and sports, customized to the patient’s symptoms.**
After a few days of rest (2-3 days), begin light activity & then gradually re-introduce regular activities (not inclusive of sports) that do not significantly worsen symptoms.
Assess school-related needs & monitor progress in collaboration with parents and school professionals.
Once back to regular non-sports activities (includingschool), patient can begin return to sports using a standard progression with gradually increasing levels of physical exertion.
No return to contact sports activity until symptom-free with exertion (including without the use of pain medication).
Six steps for returning to activityRefer
**Refer patients whose symptoms do not resolve as expected with standard care after 4-6****weeks.** In some cases, access to specialists may be limited due to required travel distance or other limitations. In these cases, consider whether telemedicine or telehealth services are possible to connect patients with specialists, depending on the need.
Symptom
Symptom
Symptom
Recommendation
Recommendation
Recommendation
**Acutely worsening symptoms**
Symptom
**Acutely worsening symptoms**
Consider neuroimaging
Recommendation
Consider neuroimaging
**Chronic headache**
Symptom
**Chronic headache**
Non-opioid analgesia (monitor for overuse), multi-disciplinary evaluation
Recommendation
Non-opioid analgesia (monitor for overuse), multi-disciplinary evaluation
**Vestibulo-ocular dysfunction**
Symptom
**Vestibulo-ocular dysfunction**
Vestibular rehabilitation
Recommendation
Vestibular rehabilitation
**Worsening sleep problem**
Symptom
**Worsening sleep problem**
Sleep hygiene, sleep specialist
Recommendation
Sleep hygiene, sleep specialist
**Cognitive impairment**
Symptom
**Cognitive impairment**
Treatment directed at etiology, neuropsychological evaluation
Recommendation
Treatment directed at etiology, neuropsychological evaluation
**Emotional dysfunction**
Symptom
**Emotional dysfunction**
Psychotherapeutic evaluation and treatment
Recommendation
Psychotherapeutic evaluation and treatment
							
					
						Page last reviewed:  August 9, 2022					Content source: 	Centers for Disease Control and Prevention, National Center for Injury Prevention and Control homeTraumatic Brain Injury & Concussion (TBI)Get the Factsplus iconTBI DataHealth DisparitiesTBI in the WorkplacePreventionMild TBI and Concussionplus iconSymptomsGetting BetterRepeated Head ImpactsModerate and Severe TBIplus iconPotential EffectsRecoveryWhere to Get HelpPublications and ReportsResearch and Programsplus iconNational Concussion Surveillance SystemResources for Healthcare Providersplus iconMild Traumatic Brain Injury Guideline for AdultsCDC Pediatric mTBI Guidelineplus iconCDC Pediatric mTBI Guideline ChecklistHEADS UP to Health Care ProvidersPress Roomplus iconLiving with TBIHEADS UP Campaign To receive email updates about this topic, enter your email address: Email Address			What's this?				Submit


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue